tbuckley/cabot-search huggingface dataset:
Abstract P666: Prevalence and Determinants of Left Ventricular Structural Abnormalities and Diastolic Dysfunction in Asymptomatic Mexican Americans Living in South Texas
Authors: Miryoung Lee, Soumya Patnaik, Neha M Paul, Emma Molina, David D McPherson, Joseph B McCormick, Susan P Fisher-hoch, Susan T Laing
Journal: Circulation (2023)

Left ventricular hypertrophy (LVH) and concentric LV remodeling (CR) are precursors to development of clinical heart failure (HF), and are associated with obesity, hypertension (HTN) and diabetes mellitus (DM), which are highly prevalent in Mexican Americans. Our study aimed to determine the prevalence of subclinical LV structural abnormalities (LVH or CR) and LV diastolic dysfunction (LVDD) in a sample of asymptomatic Mexican Americans in South Texas and determinants of these LV structural abnormalities. Methods: Demographic, cardiometabolic biomarkers, and body composition data were obtained in 1208 participants (66.3% females, mean age 53.0±0.4 years) without any CVD history from the community-based Cameron County Hispanic Cohort study. Echocardiography was used to determine LVH/CR (linear method) and LVDD was assessed using national guidelines. Those with LV systolic dysfunction (n=26) were excluded. Abdominal adiposity was determined by abdominal visceral fat mass (VAT) from dual-energy X-ray absorptiometry. Weighted ordinal logistic regression analyses were conducted adjusting for demographic and clinical covariates. Results: Weighted prevalence rates of LVH (16.6% ± 1.7%), CR (40.7% ± 2.0%) and LVDD (24.2% ± 1.8%) were high in this cohort. In men, age (p&lt;0.01), obesity (p=0.04) and HTN (p&lt;0.001) were positively related to LV abnormalities. In women, age (p&lt;0.001), obesity (p&lt;0.01), education (p=0.02), HTN (p&lt;0.01) and DM (p&lt;0.01) were related to LV abnormalities. VAT was associated with LV abnormalities in women (p=0.02), but not in men (p=0.08). Conclusion: More than half of this asymptomatic Hispanic cohort had evidence of LV structural abnormalities and almost a quarter had subclinical diastolic dysfunction. We noted a gender interaction, with diabetes and abdominal obesity seen to be significantly related to cardiac abnormalities only in women. Identifying subclinical changes in cardiac function in these high-risk patients may mitigate progression to clinical HF by early intervention.
Abstract P325: Adverse Clinical Outcomes in Non-Alcoholic Fatty Liver Disease Patients Admitted With Heart Failure and Chronic Kidney Disease
Authors: Leonid Khokhlov, Amr Aboelnasr, Leanne Pereira, Michael Fatuyi, Mehnaaz Ali, Fatima Hussain, Amanda Brown, Kamal Shemisa
Journal: Circulation (2023)

Background: Patients with heart failure (HF) are increasingly affected by (CKD). There is a growing evidence connecting Non-Alcoholic Fatty Liver Disease (NAFLD) with poor health outcomes. Nevertheless, there is limited scientific evidence of clinical outcomes in NAFLD population with HF and CKD. Therefore, we sought to investigate this population. Methods: We queried NIS between 2016-2019 for adult patients who were hospitalized with HF and CKD and had NAFLD. The primary outcome was inpatient mortality. The secondary outcomes were cardiogenic shock, cardiac arrest, gastrointestinal bleeding (GIB), acute kidney injury (AKI), invasive mechanical ventilation, length of stay (LOS) and total hospital charge. Multivariable logistic and Poisson regression analyses were used to estimate clinical outcomes. P-value &lt; 0.05 was significant. Results: There were 9,221,158 patients with HF and CKD, of which 405,290 (4.3%) had NAFLD. NAFLD and non-NAFLD cohorts were with mean age of 68.4 vs. 72.7 yrs; males 57.2% vs 53.5%; Caucasians 60.1% vs 63.4%; systolic HF 44.2% vs 41.7%; obesity 21.3% vs 23.0%; dyslipidemia 43.3% vs 56.1%; anemia 24.3% vs 22.4%, DM 59.3% vs 57.7%; AF 43.6% vs 43.5%; history of MI 12.6% vs 16.1%; stroke 1.9% vs 2.2%, COPD 30.5% vs 34.3%, respectively. NAFLD cohort had significantly higher mortality and worse clinical outcomes (Table 1). Conclusion: HF patients with co-existent CKD who were affected by NAFLD demonstrated significantly worse clinical outcomes and higher resource utilization. They were younger, male, with prevalent systolic HF, anemia, diabetes, AF. NAFLD is associated with increased GIB and AKI and may raise risk for systolic dysfunction and coagulopathy. Early NAFLD detection and management in HF and CKD population may improve clinical outcomes. Clinicians should be aware of this negative predictor when managing patients with HF&amp;CKD. Further research is needed to describe this population.
Abstract P593: Urinary Nitrate Was Not Associated With Prevalence of Dyslipidemia Among Adults in the National Health and Nutrition Examination Survey, 2009-2016
Authors: Andrew Y Hwang, Colin R Carriker
Journal: Circulation (2023)

Introduction: Exogenous dietary sources of nitrate (green leafy vegetables) and endogenous oxidation of nitric oxide are potential sources of urinary nitrate. While nitrate exposure elicits a profound impact on vascular health and higher levels of urinary nitrate correlate with reduced blood pressure, less is known about its association with blood cholesterol. Hypothesis: Higher urinary nitrate levels are inversely related to dyslipidemia prevalence. Methods: Cross-sectional 2009-2016 National Health and Nutrition Examination Survey (NHANES) was used to identify participants aged ≥20 years. Participants were categorized into four quartiles based on urinary nitrate levels (ng/mL) - Q1: ≤26,300; Q2: 26,300-45,800; Q3: 45,800-72,200; Q4: &gt;72,200. Primary analysis was survey-weighted logistic regression modeling to estimate the association of urinary nitrate with dyslipidemia prevalence (defined as self-report, total cholesterol [TC] ≥200 mg/dL, high-density lipoprotein cholesterol [HDL-C] &lt;40 mg/dL for men or &lt;50 mg/dL for women, low-density lipoprotein cholesterol [LDL-C] ≥100 mg/dL, triglycerides [TG] ≥150 mg/dL, or non-HDL-C ≥130 mg/dL). The model was adjusted for age, sex, race/ethnicity, smoking status, income level, hypertension, and diabetes. Secondary analysis included comparison of TC, HDL-C, LDL-C, TG, and non-HDL-C stratified by urinary nitrate quartiles. Survey-weighted ANCOVA, adjusted for the same co-variates, was performed at a significance level of 0.05; if significance level was met, post-hoc multiple comparison test using the Dunnett-Hsu method was performed, with Q1 as the reference. Results: Across the 8-year NHANES survey, 3,099 participants (74.7% aged &lt;60 years, 50.5% women, and 65.6% non-Hispanic white) were included in the study. Hypertension and diabetes prevalence were 24.5% and 9.3%, respectively. Urinary nitrate was not significantly associated with hypercholesterolemia prevalence (Q2 vs. Q1, OR 0.87 [95% CI, 0.62-1.23]; Q3 vs. Q1, OR 1.09 [95% CI, 0.71-1.68]; Q4 vs. Q1, OR 0.89 [95% CI, 0.59-1.37]). No statistically significant trends in TC, HDL-C, LDL-C, TG, or non-HDL-C were observed with urinary nitrate quartiles. Conclusion: Higher urinary nitrate excretion, a marker of nitrate exposure and elevated nitrate levels, was not associated the prevalence of dyslipidemia. Therefore, while a healthy diet may lead to changes in cholesterol, such changes may be independent of dietary nitrate intake.
Abstract MP19: An eGFR Polygenic Score Predicts Chronic Kidney Disease in African Americans
Authors: Alana C Jones, Amit Patki, Vinodh Srinivasasainagendra, Nicole D Armstrong, Ninad S Chaudhary, Bertha Hidalgo, Hemant K Tiwari, Nita Limdi, Donna K Arnett, Leslie Lange, Ethan Lange, Krzysztof Kiryluk, Atlas Khan, Marguerite M Irvin
Journal: Circulation (2023)

Chronic kidney disease (CKD) is a risk factor for cardiovascular disease and early death. Genetic factors contribute to CKD, and recently, polygenic scores (PGS) have been developed to quantify risk for complex diseases, such as CKD. However, African ancestry populations are underrepresented in both CKD genetic studies and PGS development overall; moreover, European-ancestry derived PGSs demonstrate diminished predictive performance in African ancestry populations. This study aimed to develop a PGS for CKD using genotype and phenotype data from African American (AA) participants of observational cohort studies. We obtained score weights from a meta-analysis of genome-wide association studies (GWAS) for estimated glomerular filtration rate (eGFR) in the Million Veteran Program (MVP) and Reasons for Geographical and Racial Differences in Stroke (REGARDS) Study (total n~66,000). We then optimized the PGS in a cohort of AAs from the Hypertension Genetic Epidemiology Network (HyperGEN) Study (n~1,900) using the PRS-CS software and evaluated the predictive performance of the PGS at multiple global shrinkage parameters. We further adjusted the PGS for APOL1 risk status. In HyperGEN, the eGFR-based PGS was significantly associated with the odds of prevalent CKD—defined as baseline eGFR &lt;60 mL/min/1.73m 2 — in logistic regression models adjusted for age, sex, and population structure. Further, accounting for APOL1 risk status—a putative variant for CKD unique to those of sub-Saharan African descent—improved the score’s accuracy, with the APOL1 -adjusted PGS explaining 1.9% (1.1% without APOL1 ) of the variance in CKD and an area under the curve (AUC) of 58.9% [95% CI: 53.0%-64.9%] (without APOL1 , 58.2% [95% CI: 52.3%-64.1%]). Sensitivity analyses and validation in external cohorts, as well as comparisons to previously published PGS, are ongoing. In this study, we developed a PGS that was significantly associated with CKD with improved predictive accuracy in AAs over previously published PGS.
Abstract P438: Physical Activity and Calcification of Coronary Arteries, Aorta, and Cardiac Valves: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Yejin Mok, Shoshana Ballew, Jennifer Schrack, Candace M Howard-Claudio, Kenneth R Butler, Lynne Wagenknecht, Josef Coresh, Matthew Budoff, Hirofumi Tanaka, Michael J Blaha, Kunihiro Matsushita
Journal: Circulation (2023)

Background: Regular physical activity (PA) has been associated with reduced risk of coronary heart disease, but conflicting results have been reported regarding its association with coronary artery calcification (CAC), one of the strongest predictors of cardiovascular disease. Moreover, different domains of PA (e.g., sports vs. work) and extra coronary calcification (ECC) have not been extensively studied in this context. Methods: We investigated 2,025 ARIC participants (age 73-95 years) who had no coronary heart disease and underwent a non-contrast cardiac-gated computed tomography scan at visit 7 (2018-19). PA was based on a modified Baecke questionnaire, which provides total and domain-specific (sport, non-sport leisure, and work) PA scores. We modeled the cumulative PA scores in middle-age at visit 1 (1987-89) and visit 3 (1993-95). We explored continuous CAC and ECC (log-transformed [Agatston score+1]) or any CAC and ECC (Agatston score &gt;0 vs. 0) as dependent variables using linear regression and multivariable logistic models, as appropriate. Results: Higher total and domain-specific PA scores showed no association with lower CAC. Among ECC, descending aorta calcification demonstrated the strongest association with total PA scores (coefficient -0.10 [95% CI -0.21, 0.01], p=0.075) ( Figure ). When specific domains were explored, higher sport and work PA scores were significantly associated with lower descending aorta calcification. When we analyzed any CAC and ECC as the outcome variable, the results were generally consistent. Conclusions: Higher PA in midlife was associated with lower calcification of descending aorta in late life. Our results further support the health benefits of PA and unique pathological process across different vascular beds.
Abstract P154: Diabetes Risk Factor Control and Infection Risk in Older Adults: The ARIC Study
Authors: Caroline Wang, Junichi Ishigami, Pamela L Lutsey, Justin B Echouffo Tcheugui, Michael Fang, Elizabeth Selvin
Journal: Circulation (2023)

Introduction: Diabetes has been tied to infection risk in mechanistic studies. However, the relationship between diabetes and infection hasn't been well documented in epidemiologic studies, especially in vulnerable older adult populations. Hypothesis: We hypothesize that diabetes will be associated with increased risk of inpatient and outpatient infection in older adults. Methods: We conducted a prospective cohort analysis of diabetes and ‘any’ and ‘hospitalized infection’ with data from the Atherosclerosis Risk in Communities (ARIC) study. Infection outcomes were ascertained with ICD9/10 codes from Medicare CMS outpatient claims and hospital discharge diagnoses (follow up from (Visit 5) 2011-2013 to December 31, 2019). We calculated the 8-year cumulative incidence of ‘any’ or ‘hospitalized” infection using Kaplan-Meier analysis. We used Cox regression to examine the association between diabetes and infection and adjusted for confounders. Results: We included 2,154 participants (mean age at Visit 5: 74.4 years, 51.4% female). During median follow up of 2.91 years, there were 1,141 incident infections and 661 incident hospitalizations with infection. Compared to those without diabetes, older adults with diabetes had higher cumulative incidence of any infection (69% vs 63%) and hospitalized infection (36% vs 27%)(Figure).This excess risk remained after adjusting for confounders, with adjusted HR for ‘any’ infection indicating a higher but non-significant risk in diabetic older patients [HR:1.12, 95% CI (0.99, 1.26)], and adjusted HR for ‘hospitalized” infection indicating a significantly higher risk in diabetic older patients [HR:1.37, 95% CI (1.16, 1.63)]. Conclusion: Given the aging American population and COVID-19 pandemic, it is critical to identify factors that increase susceptibility to infection in older adults. Our study suggests diabetes confers an increased risk for hospitalized infection in older adults. Improving diabetes management may reduce infection-related morbidity and mortality.
Abstract P394: Initial Antihypertensive Prescribing in Relation to Blood Pressure Among Medicaid and Medicare Recipients
Authors: Kayla M Smith, Almut G Winterstein, Matthew J Gurka, Marta Walsh, Shailina Keshwani, Anne Libby, William Hogan, Carl J Pepine, Rhonda M Cooper-Dehoff, Steven M Smith
Journal: Circulation (2023)

Introduction: Early treatment for hypertension (HTN) portends better outcomes. However, few real-world studies have assessed initial antiHTN regimens and how they differ by baseline blood pressure (BP). We sought to compare initial treatment patterns, stratified by BP, between Medicaid and Medicare recipients. Methods: We performed a cross-sectional study of adults with newly-treated HTN in the One Florida+ Consortium(2012-2020) who had linked claims-EHR data from the treatment initiation visit. Eligible patients were Floridians with Medicaid or Medicare aged ≥18 years, with diagnosed HTN, who filled ≥1 first-line antiHTN class with no evidence of anti HTN fills during the year prior (in which continuous insurance enrollment was required). Baseline BP was categorized per current HTN guidelines, and logistic regression was used to estimate age-adjusted odds of combination vs. monotherapy, per 10 mmHg increase in systolic BP (SBP) or diastolic BP (DBP). Results: We included 2,902 patients (47% Medicaid, 53% Medicare); mean age was 44 (Medicaid) and 67 yrs(Medicare); 60% (64% and 56%, respectively) were women and 42% (57% and 29%, respectively) were Black. Initial antiHTN classes were similar comparing cohorts: ACEI, ARB and thiazide initiation varied little by BP category, in contrast to CCBs and β-blockers (Figure, panels A-B). In age-adjusted analyses, use of initial combination therapy was 40% more likely (OR, 1.40; 95% CI, 1.11, 1.76) among Medicare recipients and inversely related to BP category (panels C-D) among Medicare patients, in which each 10mmHg greater SBP (OR, 0.93; 95% CI, 0.88, 0.97) and DBP (OR 0.82; 95% CI, 0.75, 0.90) had lower odds of combination therapy. Among Medicaid recipients, only SBP associated with combination therapy (OR1.11; 95% CI, 1.03, 1.20). Conclusions: We observed similar initial class patterns among Medicaid &amp; Medicare recipients across baseline BP, but differential use of combination therapy was less likely at higher baseline BP in Medicare recipients, which contrasts current guidance.
Abstract P261: Associations Between Adolescent Social Determinants and Adult Cardiovascular Health in the Add Health Cohort
Authors: Simon Higgins, Emma S Cowley, Lee Stoner
Journal: Circulation (2023)

Introduction: Hypertension is the leading risk factor for cardiovascular disease in the US. Individual social determinants of health (SDoH; e.g., housing and healthy food availability) are associated with hypertension in cross-sectional samples. However, there is a need to better understand how the social environment during youth impacts future hypertension risk to identify targets for primordial prevention and reduce health disparities. Objective: This study aimed to identify whether patterns of SDoH during adolescence were associated with hypertension risk during adulthood in a nationally representative sample. Methods: This analysis utilized public-use data from the National Longitudinal Study of Adolescent to Adult Health (Add Health) waves I and V (n=1,703). Using the Healthy People 2030 Framework, proxy measures for each domain of SDoH were identified from adolescent survey data (Wave I, age range 12-19 years). Blood pressure (BP) from in-home assessments (Wave V, age range age 32-42 years) was categorized as ‘normal’, ‘elevated’, or ‘hypertensive’ by ACC/AHA criteria. K-metoid (PAM) cluster analysis and assessment of silhouette width identified clusters of participants with similar patterns of SDoH during youth. Multinomial logistic regressions with bootstrapping estimated the odds of BP category membership relative to cluster membership. Models controlled for body mass index, smoking, age, sex, race, ethnicity, and medications. Analyses accounted for the complex sampling design, including appropriate Wave V weighting factors. Results: Three clusters were identified with distribution among ‘normal’, ‘elevated’, and ‘hypertensive’ BP categories, respectively, as: Cluster 1 (n=715), 40.3%, 12.3%, and 47.4%, Cluster 2 (n=499) 37.0%, 11.3%, and 51.7%, and Cluster 3 (n=489) 33.7%, 10.9%, and 55.4%. Primary differences among clusters included more frequent history of physical examinations in Cluster 1 vs. 2 and 3, and Cluster 2 vs. 3, greater feelings of safety in school and closeness to people at school in Cluster 2 vs. 1 and 3, and greater perceived prejudice at school in Cluster 1 vs. 2 and Cluster 2 vs. 3 (all p&lt;0.05). In fully adjusted models, participants in Cluster 3 had greater odds of being hypertensive than those in Cluster 1 (OR: 1.45, 95% CI: 1.02, 2.08). Black or African American participants had greater odds of elevated (OR: 2.53, 95% CI: 1.56, 4.12) or hypertensive (OR: 2.22, 95% CI: 1.58, 3.11) BP, relative to whites. Females had lower odds of elevated (OR: 0.56, 95% CI: 0.34, 0.91) or hypertensive (OR: 0.32, 95% CI: 0.23, 0.45) BP, relative to males. Conclusions: SDoH during adolescence, specifically health care access and quality, may be associated with cardiovascular health during adulthood. Future research that includes more direct assessments of each SDoH domain across the lifespan will help to identify interventional targets for primordial prevention.
Abstract P303: Time-Varying Healthy Lifestyle Profile and All-Cause Mortality Among the Oldest-Old in China
Authors: Zhengting He, Siyu Zou, Qi Guo, Beomhyeok Lee, Xian Zhang, Yaxi Li, Rundong Hu, Xiong Ding, Chaoyun Li, Xiaoyang Guo, Lijing L Yan
Journal: Circulation (2023)

Background: Association between an individual modifiable lifestyle with mortality is well established. However, influences of combined lifestyles on mortality risks remain inconclusive among adults aged 80 years or older (“oldest-old”). We investigated the association of time-varying healthy lifestyle profile (HLP) with mortality among Chinese oldest-old adults. Methods: We pooled 36,021 oldest-old adults from first seven waves of the Chinese Longitudinal Healthy Longevity Survey (1998-2014), with follow-up to latest wave (2018) (range 0-21.04 years). Lifestyle information was collected at each wave. Nonsmoking, no regular alcohol intake, regular exercise, and simplified healthy eating index of 11-18 were defined as healthy lifestyle. We assigned a score of 1 for healthy and 0 for nonhealthy lifestyle and summed the four scores to a HLP index ranging 0-5 (representing least to most healthy) to reflect joint lifestyle measurements. We used both a continuous time-to-event data set up with study enrollment as time origin (SE model) and a discrete time-to-event data set up with age 80 as time origin. We used Cox proportional hazard model with time-varying covariates and complementary log-log regression to examine hazard ratios (HRs) of mortality, adjusting for demographics, self-reported diseases, activities of daily living, and cognitive function. Results: During 110897.40 person-years of follow-up, 25,511 deaths were recorded. Median death age was 5 years older in most versus least healthy group. In SE model with least healthy group as reference, HRs (95% CIs) for mortality were 0.90 (0.86-0.95), 0.83 (0.79-0.87), 0.74 (0.70-0.78), 0.54 (0.49-0.58), respectively for HLP of 1-4 groups (p-trend&lt;0.001) ( Table ). Dose-response relationships were consistent for HRs of mortality over age since 80. Conclusion: Healthier lifestyle profiles were associated with significant reductions in all-cause mortality risks among Chinese oldest-old, suggesting the importance of life-long adherence to HLP into advanced old age.